Provider Demographics
NPI:1306584008
Name:TUTJE, JACOB DEAN
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DEAN
Last Name:TUTJE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S GRAND AVE # 714202
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6695
Mailing Address - Country:US
Mailing Address - Phone:712-324-3138
Mailing Address - Fax:
Practice Address - Street 1:1717 S GRAND AVE # 714202
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6695
Practice Address - Country:US
Practice Address - Phone:712-324-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program